by Madeleine Jennewein
figures by Rebecca Clements
Vaccines have dramatically increased life expectancy over the last 100 years, radically reshaping our communities, our economy, and the way we live our lives. As vaccination has become more widespread, the memory of the devastating impacts of infectious disease has faded, and the diseases that vaccines guard against seem less threatening. Misinformation and a lack of understanding about vaccines have also seeded doubts about their efficacy and necessity.
But vaccination remains as important as ever. Vaccines are about more than the person getting the shot—they ensure a healthy economy with strong workers, encourage the development of new and better vaccines, and help countries deal with emerging biological threats (Figure 1). Each vaccinated person is not only protecting everyone around them from getting sick, but they’re also playing a part in the larger story of national resiliency.
Vaccines and public health are important for the economy
Infectious disease is costly—the United States spends $10.5 billion every year treating seasonal flu alone. Digging deeper, the total economic burden of flu includes not just the cost of disease treatment, but also the impact of the millions of resulting sick days and thousands of lives lost, costing the United States ~$87 billion every year. Therefore, the 60% of adults who aren’t vaccinated against the flu and the almost 80% of adults who aren’t fully vaccinated against other diseases are really expensive.
Widespread vaccination can lower these costs. Vaccines protect against disease by teaching the body how to most effectively respond to a potential infection. They work on the principle that (for some diseases) once you get exposed to a pathogen, it can never get you sick again; rapidly-adapting diseases like the flu and common cold, however, are exceptions. Vaccines teach the body how to spot intruders by, in a sense, giving the body a mugshot that tells the immune system what to look for when a real invader arrives. With this mugshot, the body can recognize the criminal infection and know how to attack it.
Vaccines have allowed the worldwide economy to thrive. In the modern era, vaccines save billions of dollars every year by ensuring a more productive workforce that can work harder and live longer. And at roughly $15 a dose—frequently free for patients—these savings often outweigh the healthcare costs of widespread vaccination. For example, since 1993, the Vaccines for Children Act has enabled the government to vaccinate uninsured and underinsured children. In its first 20 years, this program saved an estimated $295 billion in direct healthcare costs and over $1 trillion in societal costs, such as lives and working hours saved.
Increasing demand for vaccine development
Even though vaccines can mitigate many common diseases, there is room for improvement: we need to improve both the vaccines themselves and the ways in which they’re administered. For emerging diseases like West Nile fever and Lyme disease, we know enough about the infections to be able to develop vaccines that are effective in animals (but not humans). Zika, Chikungunya, and other diseases that threaten that United States will also need vaccines. An increase in the number of patients asking for vaccines could drive much-needed human vaccine development.
We always need new and better vaccines, but if people aren’t getting vaccinated, then there won’t be the economic incentives to develop new ones. Ideas like a cold vaccine, a universal flu vaccine, or a vaccine that combines all childhood immunizations into a single shot need economic pressures to come to fruition. Needle-less vaccines might even work in right market. But even though vaccine production is big business in the United States, vaccine research and development is not. Therefore, research in these areas won’t get past academic laboratories without market forces.
There are many barriers to creating market incentives to increase vaccination, most notably the significant research and development costs. Patients in the developing world are in dire need of vaccines, but they often cannot afford to pay high prices for healthcare, so companies are hesitant to develop vaccines for fear that they won’t recoup their costs. Instead, growing the market for vaccines in wealthy countries could also prompt development. It is thought that a 1% increase in market size for a drug could lead to a 4-6% increase in new drugs. Therefore, a slight increase in vaccine demand in the United States will incentivize the development of vaccines that can be used all over the world. This effect is particularly striking when considering tropical diseases that are expanding their range (e.g. Dengue, Zika, West Nile, and Malaria).
Public demand, as evidenced by patients getting vaccinated and asking their doctors for the vaccines they need, is an important factor in motivating pharmaceutical companies to develop new vaccines. Adult vaccination rates are currently low in the United States, but an increase will push the market to develop these new and better vaccines.
Vaccination is a tool for global epidemic security
A major epidemic could overwhelm the world’s vaccine-production capacity. Only a few countries produce vaccines, so we cannot produce enough doses to immunize everybody. Our current capacity limits production of the seasonal flu vaccine to only 1.5 billion doses. This figure could rise to 6.5 billion for pandemic flu, which is a larger scale flu outbreak that spreads across the world like the swine flu and Spanish flu epidemics, but this is still not enough for a world population of 7.6 billion.
Pandemic vaccine production facilities are repurposed seasonal vaccine facilities, so increasing routine vaccine production will increase capacity for pandemic production. But the current production and distribution mechanisms for vaccines will not stand up to epidemic conditions. Much of this lack of vaccine capacity is a market issue—without sufficient demand, production facilities are not being updated, distribution systems are not as streamlined as they should be, and costs are rising.
The 2009 influenza outbreak, known as swine flu, demonstrated many of the issues of vaccine production in the United States. During this epidemic, it took several months to produce and distribute the vaccine. Many adults were unable to get vaccinated because of vaccine shortages. Slow, chicken egg-based production methods meant that the vaccines weren’t distributed until after infections had already peaked. This slow distribution mechanism contributed to only 20% of Americans receiving the vaccinate. Though many chose not to receive it, 11% of adults who weren’t vaccinated didn’t have access. Ultimately, over 12,000 Americans died and close to 300,000 were hospitalized. More people could have received the vaccine if it had been produced more quickly, in higher quantities, and in a more efficient dose—changes in the system would have saved lives. Luckily, this epidemic was less severe than had been predicted, but it demonstrates the challenges in vaccine production that still need to be overcome.
Adults need to get vaccinated
Vaccines benefit individual patients and the overall economy. Broader vaccination will create the economic incentives to develop new vaccines against emerging diseases like West Nile, Lyme Disease, and Zika. More demand for vaccination can spur investment in new vaccine technologies that require fewer shots (or even no shots at all). Furthermore, with more people getting vaccinated, scientists can more easily study why some people receive better protection than others. And if everyone that should get vaccinated does so, the United States will be better equipped to effectively respond to epidemics. Overall, getting vaccinated not only benefits you and your community, it also helps the nation build its capacity to respond to epidemics. So, what are you waiting for? Go get your shots!
Madeleine Jennewein is a fourth-year Ph.D. student in the Virology program at Harvard University.